Person:

Emmons, Karen

Background: This paper presents the study design, intervention components, and baseline data from Open Doors to Health, a study designed to address social contextual factors in colorectal cancer (CRC) prevention for low-income, racial/ethnic minority populations. Methods: A cluster randomized design with 12 housing sites as the primary sampling units was used: 6 sites were assigned to a "Peer-led plus Screening Access" (PL) condition, and 6 were assigned to "Screening Access only" (SCR) condition. Study-related outcomes were CRC screening, physical activity (measured as mean steps/day), and multivitamin use. Results: At baseline (unweighted sample size = 1554), two-thirds self-reported that they were current with screening recommendations for CRC (corrected for medical records validation, prevalence was 52%), with half having received a colonoscopy (54%); 96% had health insurance. Mean steps per day was 5648 (se mean = 224), and on average 28% of the sample reported regular multivitamin use. Residents reported high levels of social support [mean = 4.40 (se = .03)] and moderately extensive social networks [mean = 2.66 (se = .02)]. Conclusion: Few studies have conducted community-based studies in public housing communities; these data suggest areas for improvement and future opportunities for intervention development and dissemination. Findings from the randomized trial will determine the effectiveness of the intervention on our health-related outcomes as well as inform future avenues of research.

Background: Despite its health benefits, physical inactivity is pervasive, particularly among those living in lower-income urban communities. In such settings, neighborhood safety may impact willingness to be regularly physically active. We examined the association of perceived neighborhood safety with pedometer-determined physical activity and physical activity self-efficacy. Methods and Findings: Participants were 1,180 predominantly racial/ethnic minority adults recruited from 12 urban low-income housing complexes in metropolitan Boston. Participants completed a 5-d pedometer data-collection protocol and self-reported their perceptions of neighborhood safety and self-efficacy (i.e., confidence in the ability to be physically active). Gender-stratified bivariate and multivariable random effects models were estimated to account for within-site clustering. Most participants reported feeling safe during the day, while just over one-third (36%) felt safe at night. We found no association between daytime safety reports and physical activity among both men and women. There was also no association between night-time safety reports and physical activity among men (p = 0.23) but women who reported feeling unsafe (versus safe) at night showed significantly fewer steps per day (4,302 versus 5,178, p = 0.01). Perceiving one's neighborhood as unsafe during the day was associated with significantly lower odds of having high physical activity self-efficacy among both men (OR 0.40, p = 0.01) and women (OR 0.68, p = 0.02). Conclusions: Residing in a neighborhood that is perceived to be unsafe at night is a barrier to regular physical activity among individuals, especially women, living in urban low-income housing. Feeling unsafe may also diminish confidence in the ability to be more physically active. Both of these factors may limit the effectiveness of physical activity promotion strategies delivered in similar settings.

Introduction: Using the Internet to promote behavior change is becoming more desirable as Internet use continues to increase among diverse audiences. Yet we know very little about whether this medium is useful or about different strategies to encourage Internet use by various populations. This pilot study tested the usefulness of a Web-based intervention designed to deliver nutrition-related information to and increase fruit and vegetable consumption among adults from working-class neighborhoods. Methods: Participants (N = 52) had access to the Web site for 6 weeks and received three e-mail reminders encouraging them to eat fruits and vegetables. The Web site provided information about overcoming barriers to healthy eating, accessing social support for healthy eating, setting goals for healthy eating, and maintaining a healthy diet, including recipes. We collected data on participants' use of the Web site, their Internet access and use, and their fruit and vegetable consumption. Results: The mean age of the participants was 46 years, 73% were white, 46% did not have a college degree, and 12% had household incomes at or below 185% of the federal poverty index. They reported consuming an average of 3.4 servings of fruits and vegetables per day. More than half of the participants owned a computer, 75% logged onto the Web site at least once, and those who visited the site averaged 3.8 visits and viewed an average of 24.5 pages. The number of log-ons per day declined over the study period; however, reminder e-mails appeared to motivate participants to return to the Web site. Roughly 74% of participants viewed information on goal setting, 72% viewed information on dietary tracking, and 56% searched for main course recipes. Conclusion: The results of this pilot study suggest that Internet-based health messages have the potential to reach a large percentage of adults from working-class neighborhoods who have access to the Internet.